I am pleased and excited to share my new office with you! Beginning Monday, May 20th we will meet at:
1731 E. 16th Avenue, Denver 80218
It is on the corner of 16th Avenue and Williams in City Park West. Also in the building are a psychiatric nurse practitioner, play therapist and esthetician. See you there!
 Denver Walk & Talk Therapy –
Moving You Forward!
What is it?
Walk & Talk therapy is a form of psychotherapy that incorporates walking while talking about issues and problem-solving.
It is a workout?
Not necessarily. Walking helps get the blood moving, thus encouraging more on-the-spot thinking and creativity. We will walk at a pace where you feel comfortable.
What if I can't walk for 45 minutes?
No problem! We will walk at a comfortable pace and distance. There are benches throughout the parks if we need to sit for awhile.
What about the weather?
You decide if you’re willing to brave the elements. If the weather is inclement, we can meet at my office. However, some people find walking in the soft rain or gently falling snow invigorating.
What should I wear?
Dress comfortably and wear good walking shoes. You might consider bringing a hat or sunglasses, as well as a bottle of water.
Where will we meet?
The initial session will take place in my office so we can complete intake paperwork.
Subsequent visits will take place at either City Park (Mondays), Cheesman Park (Wednesdays), or Washington Park (Fridays). Meet-up location and directions will be given before the appointment.
Is this a good option for my child?
Walk & Talk therapy is an excellent option for adolescents who have trouble opening up to adults and expressing their feelings. An ‘office without walls’ helps youth feel free to talk more openly.
What about confidentiality?
Many people walk through the park at any given time. We will be talking about private issues and others may overhear bits and pieces of our conversation. However, we will take appropriate measures to ensure that your confidentiality is maintained to the best of our ability.
 How many of you are ‘outdoor kids’? I know I am! After living in Florida and now Colorado, I've come to appreciate my time outside running, hiking, camping, biking and walking, either alone or with friends. Sitting inside on a sunny day (or any day for that matter!) makes me feel antsy, like I should be outside doing something. I've determined that feeling at least partially stems from my younger years in the Midwest, where nice days seemed few and far between.
Know what else makes me (and lots of other people) feel restless? Sitting in an office. Close your eyes for a moment and imagine yourself at your workplace (OK, read through this first, and then close your eyes!). Are you sitting in front of a computer? Are you surrounded by four walls? Can you hear the buzz of the florescent lighting? You yawn and find it difficult to concentrate. You go for a second (or third?) cup of coffee to make it through the afternoon, yet your creativity is lacking and you just can’t find a solution to the problem at hand. Sound familiar?
Now, close your eyes once again and vision yourself as a child, running around outside barefoot on a summer day. Picture you talking and laughing with a friend. The sun is bright and warms your skin. Birds are chirping in the trees and you feel a slight breeze. Your blood is pumping and you feel energized. The surroundings ignite your imagination, and you develop a plan to conquer the bad guy or change the world. When you finally get called in for the night, you think about your successful adventure…and your body and mind rest peacefully.
The bottom line: Inactivity causes our heart rate to slow, reducing blood flow to our brain and to the rest of our body, blocking our vision and ingenuity. It can also lead to health problems. On the contrary, being active has physical and mental effects. Positive effects. Personally and professionally I have experienced this connection between the mind and body, and more studies are showing the link between mental and physical health (Good for you, science!). Clearly, some medical challenges can be overcome with exercise, and we now know that depressive and anxious symptoms (among others) are greatly reduced with exercise too.
So if movement improves our physical health and mental clarity, shouldn't we combine them?
Absolutely! It’s called: Walk & Talk Therapy.
This style of therapy has been around for several years, and it is a big contrast to sitting on a couch talking about problems. Sitting stagnant in an office can sometimes result in dull problem-solving skills, but walking outside gets the blood flowing to your brain, thus improving positive thoughts, creativity and problem-solving skills.
We’ll talk details of Walk & Talk Therapy in Part 2…
 Nancy A. Melville Nov 16, 2012
SAN DIEGO, California – The benefits of exercise in nearly every aspect of physical health are well known, but evidence in recent years suggests a unique effect on some psychiatric disorders, prompting mental health clinicians to rethink treatment strategies and to consider the possibility of exercise not just in therapy but as therapy.
"Above and beyond the standard benefits of exercise in healthy living and general well-being, there is strong evidence demonstrating the ability of exercise to in fact treat mental illness and have significant benefits on a neurotrophic, neurobiologic basis," Douglas Noordsy, MD, told delegates attending Psych Congress 2012: US Psychiatric and Mental Health Congress.
Some of the strongest evidence is seen in depression, where psychiatric benefits from exercise have been shown in some cases to match those achieved with pharmacologic interventions and to persist to prevent remission in the long term.
Dr. Noordsy referenced a study from researchers at Duke University in which 156 patients with major depressive disorder (MDD) were randomly assigned either to aerobic exercise, sertraline therapy (50 mg to 200 mg), or both for 4 months.
The difference in remission rates in the exercise and selective serotonin reuptake inhibitor (SSRI) groups after 4 months were not significant – 60% and 69%, respectively, but at a 10-month follow-up, the exercise group showed a significantly lower relapse rate ( P = .01) ( Psychosom Med 2000;62:633-638).
"The patients who were independently exercising on their own after the treatment period had half the odds for meeting the depression criteria 6 months later compared to patients who didn't exercise after the 4-month study," said Dr. Noordsy, an associate professor and director of psychosis services at the Geisel School of Medicine at Dartmouth College, in Hanover, New Hampshire.
A similar study from the same group of researchers 10 years later in a larger sample involving 202 patients assigned to supervised exercise, sertraline therapy (50 mg to 200 mg) or placebo showed remission rates of 46% at 4 months and 66% at the 16-month follow-up across both treatment groups, with no significant greater improvement with SSRIs compared with exercise in predicting MDD remission at 1 year ( Psychosom Med 2011 Feb-Mar;73:127-33; epub 2010 Dec 10).
Other studies have shown equally impressive results in exercise for a variety of populations, including pregnant women with depression, who have a high interest in avoiding medications, people with HIV, and even patients with heart failure, who showed not only a significant reduction in depression related to exercise but also reduced mortality ( Am J Cardiol 2011;107:64-68).
Anxiety
The evidence in relation to anxiety, although not as strong, still suggests a benefit, and the rigors of a cardiovascular workout seem particularly suited to addressing the physiologic effects associated with anxiety, Dr. Noordsy said.
"We know that with anxiety, the heart rate goes up, you start breathing fast, and it kind of snowballs with more anxiety, and that can trigger a panic attack," he explained.
"So one of the important positive effects of physical exercise is it allows people to become conditioned to having their heart rate and respiratory rate increase when they're not associated with anxiety, thereby addressing the triggers."
Evidence is somewhat lacking in the area of bipolar disorder, but patients often have symptoms similar enough to depression to suggest a benefit, Dr. Noordsy said.
"The evidence on depression in bipolar disorder is strong enough that I certainly feel comfortable in talking about exercise as part of [bipolar patients'] management."
In terms of more serious psychotic disorders such as schizophrenia, evidence is limited on benefits of exercise for the core symptoms of psychosis or cognition. However, several studies have shown improvement in comorbidities and metabolic issues related to antipsychotics that such patients commonly face.
One study of a jogging intervention among 80 inpatients with chronic schizophrenia, in which 40 patients jogged for 40 minutes 3 times a week, depression, anxiety, phobia, and obsessive-compulsive behaviors declined significantly compared with 40 inpatient control participants who were inactive and showed no improvement.
Dementia Prevention
The evidence on the benefits of exercise in cognitive function disorders, such as dementia and Alzheimer's disease, is much more extensive, with as many as 8 strong studies on dementia alone in the last 3 years showing improvements with activities such as walking and strength training on memory and executive function.
Dr. Noordsy noted one particularly remarkable study in which researchers compared patients with and without the ApoE gene, which is linked strongly to late-onset Alzheimer's disease.
In the study, patients who were ApoE-negative showed similarly low mean cortical binding potential, related to plaque buildup in the brain, regardless of whether they exercised or not.
But although ApoE-positive individuals (n = 39) had values that were substantially higher, the ApoE-positive patients who exercised (n = 13) had values similar to those who did not carry the gene ( Arch Neurol 2012;69:636-643).
"You could look at these results and rightfully say physical exercise neutralizes your risk for developing Alzheimer's disease if you're ApoE positive," Dr. Noordsy said.
The bottom line: "Instead of 'this is something you ought to be doing,' we might instead say, 'this is something humans are designed to do, and when we don't do it, our bodies and brains fall apart'."
Read the rest of the article on Medscape.com here. Psych Congress 2012: US Psychiatric and Mental Health Congress. Presented November 9, 2012.
 http://visual.ly/how-carve-your-thanksgiving-calories It's that time of year again! Time for family and friends. Time for holiday spirit. And time for parties. Those three things combined can also mean too much of a good thing!
It's our culture's tradition to be festive and indulgent this time of year. But how can we enjoy the holidays without over-stuffing ourselves on food, drink and fun?
Here are a few tips:
1. Be social Focus on the festivities, rather than food or drinks. Spend your time chatting with people instead of standing in the kitchen or around the bar.
2. Be green Be the one who brings green to the table. Salads, veggies and fruits are healthy and filling options.
3. Be active Don't take a holiday from your healthy lifestyle. Run, walk, ski, hike or go to the gym. On non-party days, follow your usual nutrition plan, and scale back on calories after a gathering.
We can enjoy the holidays and still maintain a healthy lifestyle. So Healthy Holidays to you and yours!
 November 14, 2012 is World Diabetes Day. Diabetes is a chronic disease that arises when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces. Insulin is a hormone made by the pancreas that enables cells to take in glucose from the blood and use it for energy. Failure of insulin production, insulin action or both leads to raised glucose levels in the blood (hyperglycemia). This is associated with long-term damage to the body and the failure of various organs and tissues.
Diabetes is difficult. It imposes life-long demands on people with diabetes, requiring them to make multiple decisions related to managing their diabetes. People with diabetes need to monitor their blood glucose, take medication, exercise regularly and adjust their eating habits. Furthermore, they may have to face issues related to living with the complications of diabetes and may be required to make considerable psychological adjustments.*
Five Tips for Coping with Diabetes:
1. Comply with practitioners’ recommendations
Not many people want to be reliant on medication or supplements. However, missing a dose of prescribed meds/treatments can lead to withdrawal, headaches, anxiety, depression and other physical and emotional symptoms. Make it a daily goal to take medicine and use other treatments as prescribed.
2. Find support
A trustworthy support network of family and friends will give you moral support. A counselor can help you work through your issues and set goals without judgment. Support groups designed for people with the same diagnosis can help you realize that you are not alone in your journey.
3. Exercise
Daily exercise increases blood flow to your brain and increases the “feel good” chemicals (endorphins). Physical movement along with outdoor activities leaves us feeling happy and satisfied. Talk with your doctor about the right kinds of exercises for you.
4. Understand what you can control
Making a list of “Things I can’t control” and “Things I CAN control” helps put our power into perspective. There are very few things we can’t control…and countless things we can! Be sure to include traditional and alternative medicine, emotions, behaviors and relationships in your lists.
5. Be positive
Being optimistic and confident both inwardly and outwardly lead to increased positivity…which improves mental and physical health. Create a motto or mantra with positive key words that you can repeat daily to yourself.
Being diagnosed with a chronic medical condition like diabetes doesn’t have to be the end of the world…it can be the beginning of discovering your true strengths and abilities!
* Taken from the International Diabetes Foundation: http://www.idf.org/
 In 1990, the U.S. Congress established the first full week of October as Mental Illness Awareness Week (MIAW) in recognition of NAMI's efforts to raise mental illness awareness. Since 1990, mental health advocates across the country have joined together during the first full week of October in sponsoring many kinds of activities.
What is Mental Illness: Mental Illness FactsMental illnesses are medical conditions that disrupt a person's thinking, feeling, mood, ability to relate to others and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life.
Serious mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, post traumatic stress disorder (PTSD) and borderline personality disorder. The good news about mental illness is that recovery is possible.
Mental illnesses can affect persons of any age, race, religion, or income. Mental illnesses are not the result of personal weakness, lack of character or poor upbringing. Mental illnesses are treatable. Most people diagnosed with a serious mental illness can experience relief from their symptoms by actively participating in an individual treatment plan.
In addition to medication treatment, psychosocial treatment such as cognitive behavioral therapy, interpersonal therapy, peer support groups and other community services can also be components of a treatment plan and that assist with recovery. The availability of transportation, diet, exercise, sleep, friends and meaningful paid or volunteer activities contribute to overall health and wellness, including mental illness recovery.For more info, visit: http://www.nami.org/template.cfm?section=about_mental_illness
 October is National Bullying Prevention Month Join the movement!
The End of Bullying Begins with Me: that’s the message during PACER’s National Bullying Prevention Month in October. It’s a time when communities can unite nationwide to raise awareness of bullying prevention through events, activities, outreach, and education. Resources from PACER’s National Bullying Prevention Center make it easy to take action.
PACER created the campaign in 2006 with a one-week event which has now evolved into a month-long effort that encourages everyone to take an active role in the bullying prevention movement.
We have a variety of resources you can use during October — and throughout the year — to engage, educate, and inspire others to join the movement and prevent bullying where you live. Check out all of the different events and activities and make plans to get involved. Remember, the End of Bullying Begins With You!
Unity Day: Wednesday, Oct. 10 – Mark your calendar now and make plans to wear orange on Unity Day. That’s when scores of people around the country will join the movement to “Make it Orange and Make it End!” In 2011, Ellen DeGeneres promoted the cause on television by wearing orange and reminding millions of viewers about the importance of bullying prevention. Facebook supports the cause during October by providing users with information on PACER activities on its safety, educator, and privacy pages. Again in 2012, students will wear orange and use PACER resources to support the cause, hand out orange “UNITY” ribbons at school, and write “UNITY” on their hands or binders. Be sure to ‘Attend’ and ‘Share’ the Unity Day Facebook Event!
http://www.pacer.org/bullying/nbpm/
 Psychology Today: Autumn Now
The rhythm of fall -- energy and excitement
Published on October 24, 2010 by John Sharp, M.D. in The Emotional Calendar
From: The Emotional Calendar
Now that we're past the autumnal equinox, we find ourselves screaming towards Halloween. We might be enjoying Indian summer, the brief return of warmth that follows the first frost, or we might be dealing with the inexorable deepening of the fall season. The pumpkins and mums are out now and most of us are starting to accept that it's better to delve in to the pleasures, or at least the realities, of the season rather than to try to ignore them. I say, "Come on now: it's not that bad!"
Fall is a great time to practice being in the here-and-now. If you spend too much time pointed backwards, you'll find yourself reminiscing about the season past and wondering why your feet feel cold - until you look down and see you' re still wearing flip-flops. Or if you spend too much time with your glance cast forward, you'll start shivering before you need to. Winter is not here yet! I say, "Be here, now." Don't think of this time as a segue from one well-defined period to another. Think of it as a whole, lovely season that fits nicely between summer and winter.
Fall is a very emotional time of year, filled with loads of memories, many of them associated with back-to-school. Getting ready, getting ready, getting ready! Fall sometimes feels a bit like a Sunday evening, a time that is so focused on tomorrow. But then, as you get into the rhythm of fall, there's a linear energy and excitement that carries us forward and sustains us. All along the way there are sights and smells and sounds that remind us of what we might have experienced in falls past - reminders of event anniversaries and moods. Remember the time when...?
September, October, and November are not always easy months, but they are emotionally rich for most of us. I love them and hopefully you can too. Here are three secrets to making the most of them in your own unique way:
1. Don't give up on fall! Sometimes we give up before we even try to appreciate the season. Some people who say they "hate" the fall, don't really give it a fair shake. Why? They may be fast-forwarding to what they consider the "worst" part of the season. They don't even try to be "in" the fall, or find its good parts, because they are so focused elsewhere. Be there. Don't worry about December. Forget about the Fourth of July. Now is now.
2. Consider the fall as its own unique world. Take a good look around. Forget judgment and prejudice for a moment. Let yourself be fascinated by the customs of fall. See the season as a whole and coherent experience, colored in with light and tone and temperature and smell and texture and taste. Remark to yourself on how this all actually works and works well. Fall is a time that makes a lot of sense. It is right, you must tell yourself. The world of fall deserves to be explored and experienced for its natural beauty. And you deserve to give yourself an honest chance to know it and enjoy the season.
3. Identify the very best thing possible about fall for you. Find the best, most realistic way of thinking about yourself in the context of this very fall, the best mentality you can conceive of that fits, and then conceptualize something that you can go and do with that - perhaps an activity or special sojourn that would be memorable and authentic. Then go to it. The fall is usually a great time for a little road trip - someplace close though, nothing too difficult. Sometimes it's nice to get away and do something, and sometimes its nice to get away and then do as little as possible.
The other day, I was talking with a taxi driver who had a very nice idea for himself. He was looking forward to a quick get away at the end of October. "I do it every year," he said, "before it really gets - you know - crazy." He likes to go to Las Vegas, exercise in the hotel gym, go out to eat, and watch sports. "I'm not a gambler," he explained. "I'd rather have a great meal for a hundred bucks than lose it on the slots." Whatever you might like, I love and support the idea of a mid-fall break. And it doesn't even have to involve travel. Make a date to do something nice for a few days - or for just a few hours.
One good trick is mid-fall treat.
Having self-esteem and self-confidence can help up reach our goals. However, these two concepts have different meanings. Self-confidence is the belief in our ability to do accomplish goals, while self-esteem is the belief in our worthiness. We can raise our self-esteem with the tips below:
1. Lift up others: Be supportive, helpful and generous...not just with your money, but with your time and attention.
2. Step out of your comfort zone: Try something new or challenging. Don't be afraid of failure...we learn from our mistakes.
3. Give and Take: Give help to those in need and don't be afraid to ask for help when you need it.
4. Forgive and forget: Spending mental energy on events of the past keeps us stuck there. Move on and grow!
5. Applaud others: We love to get attention, and it feels just as good to pass it on. The positive energy will come back in abundance.
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